Analysis of risk factors for complications after Nuss procedure for pectus excavatum

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Objective To analyze the Nuss procedure results, risk factors responsible for postoperative complications and management of postoperative complications. Methods We restrospectively reviewed the clinical data of pectus excavatum (PE) patients undergoing Nuss procedure from September 2009 to April 2016.There were 68 boys and 7 girls, 59 children patients and 16 adult patients, 66 patients with one bar and 9 patients with two bars implanted. Results Seventy-five patients were recruited and all operations were completed successfully.In 30 patients, bars were removed successfully during a median follow-up period of 36 (33-46) months.In 29 patients, chest wall deformities were corrected during a median follow-up period of 23 (1-43) months.In 44/45 patients, chest wall deformities were corrected during a median follow-up period of 22 (5-40) months.There was no severe intraoperative complications.No death occurred perioperatively.Postoperative recent complications occurred in 16 patients (21%). Early complications of pneumothorax (n=10), incision malunion (n=4), pleural effusion (n=1) and temporary brachial plexus paralysis (n=2) were managed successfully.Two cases of late complications underwent redo Nuss procedure with satisfactory outcomes.Both univariate and multivariate analyses showed that PE symmetric or not (OR=7.045, P=0.011), age (OR=7.416, P=0.011) and numbers of bars implanted (OR=15.180, P=0.005) were independent risk factors for postoperative complications after Nuss procedure. Conclusions Nuss procedure is both safe and effective for correcting pectus excavatum.Early and late postoperative complications are mild and acceptable and may be handled actively and successfully.Age 18 years and above, asymmetric PE and internal fixation requiring 2 bars are independent risk factors for postoperative complications after Nuss procedure. Key words: Funnel chest; Corrective operation of pectus exca-vatum; Complications; Risk factors